Efficacy of Cerebral Oxygen Saturation Monitoring for Perioperative Neurocognitive Disorder in Adult Non-cardiac Surgical Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Lingqin Qiu, Yabing Ma, Li Ge, Haijiao Zhou, Wenqin Jia
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引用次数: 0
Abstract
Background: Perioperative neurocognitive disorders (PND) are common perioperative complications associated with various poor outcomes. Regional cerebral oxygen saturation (rSO2) monitoring is a non-invasive technique based on near-infrared spectroscopy detection. Due to the considerable controversy among currently published studies on the application of intraoperative rSO2 monitoring in adult patients undergoing elective non-cardiac surgery, this study aims to conduct a systematic review and meta-analysis to provide more comprehensive and robust evidence to support clinical decision-making.
Materials and methods: This study conducted a systematic literature search of databases including PubMed, Embase, CENTRAL, and Web of Science, from their inception to May 1, 2024. The eligible randomized controlled trials included adult patients undergoing elective non-cardiac surgery under general anesthesia who received optimized anesthesia management guided by rSO2 monitoring and those in the control group who received routine anesthesia management under standard monitoring or blinded rSO2 monitoring. The primary outcomes were the incidence of PND, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD), and Mini-Mental State Examination (MMSE) scores. Secondary outcomes included the incidence of intraoperative cerebral desaturation and length of hospital stay (LOS).
Results: The pooled results showed that compared to the control group, optimized anesthesia management guided by intraoperative rSO2 monitoring significantly reduced the incidence of POCD within 7 days postoperatively and may reduce the incidence of POCD at 3 months and longer periods postoperatively. However, it may not reduce the incidence of POD within 7 days or longer periods postoperatively, improve MMSE scores, reduce the incidence of intraoperative cerebral desaturation, or shorten LOS. Given the substantial heterogeneity in the pooled results for MMSE scores within 7 days postoperatively and LOS, and the limited number of studies reporting the incidence of POD, POCD, and MMSE scores after 7 days postoperatively, the related results should be interpreted with caution.
Conclusions: Despite the presence of heterogeneity and the inclusion of a limited number of studies for some outcomes, it is still recommended that clinical anesthesiologists routinely perform intraoperative rSO2 monitoring and optimize intraoperative anesthesia management based on the monitoring results to maximize rSO2 and improve cerebral perfusion, thereby improving patients' neurocognitive outcomes. Further large-scale high-quality studies are needed to confirm the conclusions of this study.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS